BeneCare’s value-based dental plans are designed to help remove the barriers to care that can suppress utilization. This encourages members to address accumulated need and consistently maintain preventive care. This creates a shift in the service distribution from treatment towards prevention, helping to lower cost trends and stabilizing premium rates over the long term.
A CASE STUDY
Through its “Benefits Connection” program, the New Castle County Chamber of Commerce (Chamber) offers group coverage for a host of insurance products to its members, including medical, dental, vision, workman’s comp, and voluntary benefits.
Initially, the Chamber’s dental insurance offerings was a mixture of plan types through a number of different carriers with different provider networks. This structure created some obstacles for its enrolled members:
- Low provider participation rates within some of the plans and carriers;
- Changing plans may require changing networks and – therefore – dentists;
- Reimbursement rates were severely under market value, resulting in balance billing issues, even for fully covered services.
These factors often presented barriers to accessing care, leading to lower utilization rates by the membership.
“BeneCare’s proposal addressed the primary pain points the Chamber was experiencing with the previous program. BeneCare also offered multiple choices at different price points.”
~Bob Chadwick, President of the New Castle County Chamber of Commerce
To help alleviate these barriers, BeneCare suggested consolidating the program under a single carrier and network. The plan was also underwritten under BeneCare’s association program, providing the membership the benefit of large group pricing and a private exchange platform.
BeneCare also analyzed the local market conditions to determine the best way to incentivize provider participation. We discovered that the provider community is relatively small, in general, and very scarce in some geographic areas. This increases the patient-to-dentist ratio, which in turn required adjustments in our reimbursement schedules to encourage participation and reduce balance billing scenarios, reflecting the local dental market conditions.
The final change was in BeneCare’s approach. BeneCare’s uses a value-based model that emphasizes the importance of moving members from emergent/episodic care into oral health maintenance focused on routine prevention. It’s both cheaper and healthier for the member and the group.
As expected, year one experienced a large spike in claims for treatment (as opposed to preventive), accounting for 79% of all dental claims. This is not atypical for a population that has previously faced barriers — either financial and/or access — to regular care. Utilization was relatively low (27%), although the numbers only represent 6 months of experience. Utilization quickly trended up in subsequent years.
Year Two & Three
In year two, the ratio between treatment and preventive services had almost completely flipped compared to year one (29% treatment vs. 71% preventive). Utilization also ticked up to 64% in year two. A premium rate stabilization increase of 4% was levied in year three and was the only rate adjustment over the five-year period.
Year four shows the effect of the COVID-19 pandemic when dental offices were shuttered for a number of months. Offices were accepting patients during the closure, but only for dental emergencies and other conditions that required timely treatment.
Year five shows the start of a return to the previous pattern experienced before the pandemic shutdowns. Utilization peaked at 72% as members returned to the dentist for preventive services and treatment started to trend downward as issues neglected during the pandemic were addressed. Even with pandemic-related office closures and temporary drop in utilization, the service mix remained more cost-favorable than in year one.
Since the plan is an association plan, the membership of this large group is comprised of many small businesses from a variety of industries. These factors make the membership much more heterogeneous than a single large group.
“Despite the complexity of the membership mix. BeneCare’s eligibility and enrollment process is easy and trouble free.”
~ Beth Fisher, Benefits Manager, New Castle County Chamber of Commerce
By removing the barriers to care that can suppress utilization, BeneCare Dental Plans helped the New Castle County Chamber of Commerce’s population address pent-up need and neglect, creating a shift from treatment to prevention. This approach can eventually lead to lower cost trends, rate stabilization, and better oral health for plan members.